Management of Patients

With Female Reproductive

Disorders
Ance M. Siallagan

Candidiasis
Candida albicans, glabrata or
tropicalis
itching, reddish irritation, White,
cheeselike discharge clinging to
epithelium
antifungal agent: vaginal creams
and suppositories
Review other causative factors (eg,
antibiotic therapy, nylon

bacterial vaginosis
Gardnerella vaginalis and vaginal
anaerobes
Gray-white to yellow-white
discharge clinging to external
vulva and vaginal walls
metronidazole

Trichomonas vaginalis
Trichomonas vaginalis
burning and itching, Frothy
yellow-white or yellow-green
vaginal discharge.
Relieve inflammation, restore
acidity, and reestablish normal
bacterial flora;
provide oral metronidazole for

Bartholinitis
Escherichia coli, Trichomonas
vaginalis, Staphylococcus,
Gonococcus
Erythema around vestibular
gland Swelling and edema,
Abscessed vestibular gland
Drain the abscess; provide
antibiotic therapy; excise gland of

Cervicitis
Chlamydia,Gonococcus,Streptococcus,
Many pathogenic bacteria
Profuse purulent discharge, Backache,
Urinary frequency and urgency
Determine the cause,cervical smear
and cultures
Eradicate the gonococcal organism,
penicillin or spectinomycin or
tetracycline, doxycycline.

Atrophic vaginitis
Lack of estrogen; glycogen
deficiency
Discharge and irritation from
alkaline pH of vaginal secretions
topical vaginal estrogen therapy;
improve nutrition; relieve dryness
through use of moisturizing
medications.

Nursing Process of Patient

With Vulvovaginal Infection

Assessment:
Physical and chemical factors
Psychogenic factors
Medical conditions or endocrine
factors
Use of medications such as antibiotics
New sex partner, multiple sex
partners, previous vaginal infection

Nursing Diagnoses

1. Discomfort related to burning, odor, or

itching from the infectious process
2. Anxiety related to stressful symptoms
3. Risk for infection or spread of infection
4. Deficient knowledge about proper
hygiene and preventive measures

Nursing Interventions
Relieving Discomfort: Sitz baths
Reducing Anxiety: Discussing ways
to help prevent vulvovaginal infections
Preventing Reinfection or Spread
of Infection: abstaining from sexual
intercourse when infected, treatment
of sexual partners, and minimizing
irritation of the affected area, perineal
hygiene

Expected Patient
Outcomes
Experiences reduced discomfort
Experiences relief of anxiety
Remains free from infection
Participates in self-care

Herpesvirus Type 2 Infection (Herpes

Genitalis, Herpes Simplex Virus)
The initial infection is usually very
painful and lasts about 1 week, but it
can also be asymptomatic.
Primary infection may begin with
macules and papules and progress to
vesicles and ulcers
Influenza-like symptoms may occur 3
or 4 days after the lesions appear
Inguinal lymphadenopathy, minor
temperature elevation, malaise,

Nursing process of patient

with a genital
herpesvirus infection
Assessment:
health history
physical and pelvic examination:
perineum, Inguinal nodes,
enlarged and tender during an
occurrence of HSV.

Nursing Diagnoses

1. Acute pain related to the genital

lesions
2. Risk for infection or spread of
infection
3. Anxiety related to the diagnosis
4. Deficient knowledge about the
disease and its management

Nursing Interventions
Relieving Pain: Sitz baths,
Clothing should be clean, loose,
soft, and absorbent; Aspirin,
Occlusive ointments and powders
Preventing Infection and Its
Spread: hand washing, use of
barrier methods with sexual
contact, and adherence to

Cont
Relieving Anxiety: Concern about
the presence of herpes infection,
future occurrences of lesions, and the
impact of the infection on future
relationships and childbearing;
assistance and support in discussing
the infection and its implications;
support group to assist in coping with
the diagnosis
Increasing Knowledge About the

Expected Patient
Outcomes
Experiences a reduction in pain and
discomfort
Keeps infection under control
Uses strategies to reduce anxiety
Demonstrates knowledge about
genital herpes and strategies to
control and minimize recurrences

MALIGNANT CONDITIONS
Cervical cancer
Uterine cancer
Ovarian cancer
Vaginal cancer
Vulvar cancer

Cancer of the Cervix

predominantly squamous cell cancer
HPV infection
spread to regional pelvic lymph nodes
vaginal discharge after intercourse
(douching), irregular bleeding, pain or
bleeding after sexual intercourse occur.

Risk Factors
Multiple sex
partners
Sex with
uncircumcised
males
Sexual contact
with males whose
partners have had
cervical cancer
Early childbearing

HIV infection
Smoking
Diethylstilbestrol
Family history
Low socioeconomic
status
Nutritional
deficiencies
Chronic cervical
infection

Diagnostic
Pap smear
x-rays
laboratory tests
punch biopsy and colposcopy; dilation
and curettage;
computed tomography (CT),
magnetic resonance imaging (MRI)
IV urography, cystography, positron
emission tomography, and barium xray

Medical Management

Preinvasive
Cryotherapy
Lesions
laser therapy
loop
electrocautery
excision
procedure
(LEEP)
Cone biopsy or
conization

Invasive Cancer

Surgery
Radiation
treatment
Brachytherapy
pelvic
exenteration

Cancer of the Uterus

(Endometrium)
Risk Factors:
Age: at least 55 years; median
age, 61 years
Obesity
Unopposed estrogen therapy
nulliparity, truncal obesity, late
menopause (after 52 years of
age) and use of tamoxifen

Cont

Diagnostic: endometrial aspiration or

biopsy, Ultrasonography
Medical Management:
total or radical Hysterectomy;
bilateral salpingo-oophorectomy
Adjuvant radiation: Vaginal
brachytherapy
Progestin therapy

Cancer of the
Vulva
Medical Management:

Risk factor:
smoking, HPV/ HIV
infection,
immunosuppression

Local excision, laser

ablation,chemotherapeu
tic creams, or
cryosurgery (preinvasive
Manifestations:
lesion)
Long-standing pruritus Vulvectomy (invasive)
and soreness
External beam radiation
Bleeding, foul-smelling Laser therapy &
Type:
chemotherapy
discharge and pain

Early lesions appear

as a chronic dermatitis
Ulcerated
cauliflowerlike
growth

Squamous cell
carcinoma
Bartholins gland
cancer,
vulvar sarcoma,

Nursing Management

Assessment:
health history
patients health habits and
lifestyle
Psychosocial factors and support
Preoperative preparation

Preoperative Nursing
Interventions
Relieving Anxiety: learns that the
possibility for subsequent sexual
relations is good and that pregnancy is
possible after a wide excision.
Preparing Skin for Surgery:
cleansing the lower abdomen, inguinal
areas, upper thighs, and vulva with a
detergent germicide for several days
before the surgical procedure.

Postoperative Nursing
Interventions
Relieving Pain: analgesic, low
Fowlers position.
Improving Skin Integrity:
Ambulation, transparent dressing,
normal saline irrigations or other
antiseptic solutions
Supporting Positive Sexuality and
Sexual Function: discuss her
concerns with her sexual partner,
Referral of to a sex counselor may

Monitoring and Managing Potential

Complications:
infection: purulent drainage, redness,
increased pain, fever, and increased white
blood cell count
Catheters, drains, and dressings are handled
carefully with gloves, Antiembolism
stockings
DVT (leg pain, redness, warmth, edema)
Pulmonary embolism (chest pain,
tachycardia, dyspnea).
hemorrhage and shock (fluid replacement,

 Teaching Patients Self-Care: about

wound care, urinary catheterization,
and possible complications.
Continuing Care:
patients physical status and
psychological responses to the surgery;
home visit ; Follow-up phone calls;

Cancer of the Vagina

Risk factors include previous
cervical cancer, in utero exposure
to diethylstilbestrol (DES),
previous vaginal or vulvar cancer,
previous radiation therapy,
history of HPV, or pessary use.
surgery, radiation therapy
including external beam radiation

Cancer of the Fallopian

Tubes
Symptoms include abdominal
pain, abnormal bleeding, and
vaginal discharge
An enlarged fallopian tube may
be found on sonogram if dilated
and fluid filled or it may appear
or be palpated as a mass.
Surgery followed by radiation
therapy is the usual treatment.

Cancer of the Ovary

increased abdominal girth, pelvic
pressure, bloating,
back pain, constipation, abdominal
pain, urinary urgency, indigestion,
flatulence, increased waist size, leg
pain, and pelvic pain.
total abdominal hysterectomy with
removal of the fallopian tubes and
ovaries

Hysterectomy
surgical removal of the uterus to
treat cancer, dysfunctional uterine
bleeding, endometriosis,
nonmalignant growths, persistent
pain, pelvic relaxation and
prolapse, and previous injury to
the uterus

NURSING PROCESS OF PATIENT

UNDERGOING A HYSTERECTOMY
Assessment:
health history
physical and pelvic examination
laboratory tests
patients psychosocial responses

Nursing Diagnoses
Anxiety related to the diagnosis of cancer,
fear of pain, possible perception of loss of
femininity or childbearing potential
Disturbed body image related to altered
fertility and fears about sexuality and
relationships with partner and family
Acute pain related to surgery and other
adjuvant therapy
Deficient knowledge of the perioperative
aspects of hysterectomy and postoperative

Nursing Interventions
Relieving Anxiety
Improving Body Image
Relieving Pain
Monitoring and Managing
Potential Complications
(hemoragi, DVT, disfungsi
bladder)
TEACHING PATIENTS SELF-CARE
CONTINUING CARE

Radiation Therapy
Radiation may be used in the treatment of
cervical, uterine, and ovarian cancers either
alone or in combination with surgery and
chemotherapy.
Methods of Radiation Therapy:
External radiation,
intraoperative radiation therapy (IORT), and
internal (intracavitary) irradiation or
brachytherapy.

TERIMA KASIH